Active NPI
Stephan T Garrett, PAC
- Physician Assistant
- Las Vegas, NV
National Provider Identifier
1861630444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA733
- Practice address
- 2911 N Tenaya Way
Suite 105
Las Vegas, NV 89128-0464 - Phone
- (702) 252-8378
- Fax
- (702) 242-0098
- NPI assigned
- Feb 4, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA733 | NV | Primary |
Addresses
Primary practice location
2911 N Tenaya Way
Suite 105
Las Vegas, NV 89128-0464
Mailing address
2911 N Tenaya Way
Suite 105
Las Vegas, NV 89128-0464
Phone (702) 252-8378
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA733 | NV | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1259539200000",
"number": "1861630444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2911 N TENAYA WAY",
"address_2": "SUITE 105",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891280464",
"telephone_number": "702-252-8378",
"fax_number": "702-242-0098"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2911 N TENAYA WAY",
"address_2": "SUITE 105",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891280464",
"telephone_number": "702-252-8378",
"fax_number": "702-242-0098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARRETT",
"first_name": "STEPHAN",
"middle_name": "T",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-04",
"last_updated": "2009-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA733",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.